5 Clinical Question: For diagnosing speech andlanguage delay in late talking English speakingtoddlers, are measures of speech production (e.g.,syllable shape, phonetic inventory) and/or nonwordrepetition as accurate as currently used measures(e.g., CDI, vocabulary size)?6 papers read by group on this topic.

6 Oller, D.K., Eilers, R.E., Neal, A.R., & Schwartz, H.K. (1999).Precursors to speech in infancy: The prediction of speech andlanguage disorders. Journal of Comm Disorders, 32,Canonical babbling: infant’s production of well formed syllables,often in reduplicated sequences ‘bababa’. Mean age of onset 6months. Rarely begins later than 10 months. True for childrenfrom low and very low SES areas.Results:Infants with confirmed, late onset canonical babbling had smaller expressive vocabularies at 18, 24, 30 months than controls. No sig differences in comprehension. Small sample<50% who babbled later than 10 months had sig medical dx. They were excluded from follow up studies at 18, 24 months

8 Results (Highman, Hennessy et al 2008):Preliminary support for notion of differences inpre-linguistic vocalisations of children with sCAS.2. Similarities between sCAS & SLI group cf TD groupsCAS & SLI groups differed on following measures;35% sCAS group reported never babbled (TD SLI did)2 word combinations later for sCAS than SLI & TDsCAS group met some motor m/stones later SLI & TD4. No differences between groups for feeding or dribbling

13 Clinical Bottom Line: Clinical bottom line for each paper (CAP).Clinical Bottom Line:Clinical bottom line for each paper (CAP).Combined clinical bottom line for the topic (CAT)Affirm or change practiseTells clinicians how to apply the available evidence clinicallyIs informed by consideration of Level of Evidence, comments on design, and robust discussion among the group.

14 Clinical Question: For diagnosing speech and language delayin late talking English speaking toddlers, are measures ofspeech production (e.g., syllable shape, phonetic inventory)and/or nonword repetition as accurate as currently usedmeasures (e.g., CDI, vocabulary size)?Clinical Bottom Line:No definitive study proving these measures are equally reliable or could replaced current methods of practice.However, research suggests that measures of children's speech and non-word repetition ability that could contribute to the accurate diagnosis of speech/language delay in toddlers.

15 Clinical Bottom Line (cont’d):The focus for many years has been on language of LTs. Theresearch suggests that SLPs may benefit from also consideringchildren's speech production skills (small phonetic inventories,little change in phonological skills over time, small word shapeinventory), and their possibly NWR abilities (4-syllables words –preliminary findings).

16 Additional Clinical Bottom Line Information…There is a relationship between measures of lexicaldevelopment (eg vocab size, word combinations) and phonetic inventory in LTs. They have smaller vocabularies and reduced phonetic inventories.The predictive value of either measure not clearly supported over a number of studies. Preliminary investigations suggest qualitative phonological measures (with quantitative measures), and babbling onset and type are potential variables factors for further studyHowever, severity and age at diagnosis appear to predict language outcomes at 3 years. Older a child is when diagnosed and more severe (greater developmental lag), more likely child has true speech +/or language impairment.